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Musicians Struggle To Buy Insurance In A City That Thrives On Music

NPR Health Blog - Wed, 11/11/2015 - 2:35pm
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Kalu James moved to Austin, Texas, eight years ago, but bought health insurance for the first time this year. Twenty percent of the city's musicians live below the federal poverty line.

Veronica Zaragovia/KUT

It looks like Kalu James is living the life as a musician. He's standing under a neon sign, ready to play guitar at Austin's famous Continental Club. And when he's not here, he's hustling to pay his bills.

"Being a full-time musician means you have three other side jobs, you know?" he says.

James moved to Austin about eight years ago and got health insurance for the first time this year. He pays $22 a month, after the $200 subsidy he gets through the Affordable Care Act. Even that is a lot, because he earns only $15,000 a year. He gets help paying his monthly premium through a local nonprofit.

"We still have to worry about counting the quarters and the pennies when we leave these venues," he says. Health insurance doesn't come easily.

Austin thrives on its reputation as the live music capital of the world and is making far more than quarters and pennies from music. The city estimates the commercial music industry pumps $1.6 billion into the local economy every year.

But Austin has a lot of people like James struggling to afford life here.

"A lot of people didn't understand just how dire that situation is," says Nikki Rowling, the founder and CEO of the Titan Music Group. "We have hard data that shows it."

The Titan Music Group recently conducted a large survey and several focus groups of musicians in Austin; it produced the Austin Music Census for the city. The census found that 20 percent of Austin musicians live below the federal poverty level. More than 50 percent qualify for federal housing subsidies, and nearly 19 percent lack health insurance.

A lot of Austin musicians rely on the Health Alliance for Austin Musicians for help.

"Close to 60 percent of our membership doesn't even qualify for the subsidies that are given through the Affordable Care Act," says Reenie Collins, the alliance's executive director. And Texas didn't expand Medicaid, which would have helped those musicians below the poverty line.

Her organization helps in two ways. This year, HAAM gave Kalu James and about 300 others money to afford their premiums for plans bought on the exchange. It also coordinates low-cost health care for about 2,000 members every year. It partners with doctors and hospitals to give these musicians medical, dental, vision, hearing and mental health care.

Backstage at the Moody Theater, dobro player Tom Caven is getting ready to go onstage.

"Travel anywhere in the United States," Caven says, "you tell them you're from Austin, [and] they almost always say, 'Austin City Limits,' you know? This is very much the identity. And if we lost that, we'd just be another up-and-coming city with no personality."

Caven is an executive at the Seton hospital network, an organization that partners with HAAM. He is also a physician and treated musicians in Austin for almost 20 years. Caven's band, The Stray Bullets, is performing at a local "battle of the bands" to raise money for HAAM.

"Some people feel like you just ought to work hard enough to have health insurance," he says. "But working in a safety-net hospital, like I do, you see people that come in. They're working really hard — working sometimes two and three jobs to support their family."

Dr. Tom Craven (second from right) plays dobro and guitar with The Stray Bullets. He also treated Austin musicians for 20 years and is now an executive at the Seton hospital network in the city.

Veronica Zaragovia/KUT

Thanks to fundraisers and other private donations, HAAM's Collins plans to triple the number of musicians who will get help with their premiums next year. She's also a passionate advocate of Medicaid expansion, which would help many musicians in Austin.

"Many, many people think, 'Oh, HAAM's not needed anymore.' Well, that's not really true," she says, "because Texas did not expand Medicaid."

While more people have become insured since the rollout of the exchanges, Texas still has the highest uninsured rate in the country — about 17 percent.

This story is part of NPR's reporting partnership with local member stations and Kaiser Health News.

Copyright 2015 KUT-FM. To see more, visit
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House Calls For The Homebound Make A Comeback

NPR Health Blog - Wed, 11/11/2015 - 10:56am

Misha Friedman for NPR

Credit: NPR; Photographs by Misha Friedman for NPR

Dr. Roberta Miller hits the road at 8 a.m. to see her patients.

Many are too old or sick to go to the doctor. So the doctor comes to them.

She's put 250,000 miles on her Honda minivan going to their homes in upstate New York. Home visits make a different kind of care possible.

"You can evaluate the person as a whole," says Miller, who has been a home care physician in Schenectady, N.Y., for more than 20 years. "You see everything that influences their health and well-being: the environment, the surrounding people, the support system, whether they had or didn't have food."

Miller spends about an hour at each house call. Conversation with patients and their family members flows so naturally that it's easy to miss that she's also checking vital signs, gently stretching a hand, noting which pill bottles are empty.

Although Miller's practice may harken back to the country doctor of decades past, it could be the future of medicine. In 2013, about 2.6 million Medicare claims were filed for patient home visits and house calls. That's up from 2.3 million visits in 2009 and 1.4 million visits in 1999, according to Medicare statistics.

The trend is expected to accelerate as baby boomers grow older. One in 20 people over the age of 65 is homebound in the U.S., according to a study published in July in JAMA Internal Medicine.

"That's just the nature of the population we treat," Miller says. "They're extremely ill. Homebound patients often have up to 12 or 13 problems, not just one."

And they're often invisible. These people could be living just down the block, and you'd never know it. Many of them never leave their homes.

Miller's patients include a 55-year-old woman with ALS who can communicate only with her eyes, a 27-year-old former quarterback left quadriplegic and in a coma after surgery on an Achilles tendon, a 92-year-old woman cared for by her daughter, and a severely depressed man who lives alone.

After the Affordable Care Act took effect in 2014, Miller saw a spike in new patient requests after Medicare reimbursements increased for people who are disabled or 65 and older.

"Now we can afford to see them and take care of them. Because they haven't had medical care, they have multiple medical needs and psychosocial needs," she says. "It has given us access to a group of people, but more importantly, they have access to us."

But reimbursements declined in 2015 because of sequestration. And now Medicaid reimbursements rates are starting to fall as well.

Editor's note: This is an abbreviated version of a story that ran on Sunday, Nov. 8.

Misha Friedman for NPR

Photographer Misha Friedman says he tries "looking beyond the facts, searching for causes, and asking complex and difficult questions." His work has been featured by many media organizations, including NPR, The New Yorker, Sports Illustrated, Der Spiegel and GQ.

Freelance writer Nadia Whitehead contributed to this report.

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Women In Their 40s Get Some Help With The Mammogram Decision

NPR Health Blog - Wed, 11/11/2015 - 8:42am

The online tool called Breast Screening Decisions explains the risks of screening vs. waiting, and also asks how a woman feels about the options.

Meredith Rizzo/NPR

Expert groups differ on when and how often women should have mammograms. So many groups now say that a woman in her 40s should talk to her doctor about the pros and cons of mammography as well as her individual risk in order to make the decision that's right for her.

Except that none of my 40-something friends I've spoken with have had that kind of conversation with a physician. Instead they've heard: "You're 40, here's a prescription for a mammogram." End of discussion.

Next year I'm determined to actually talk over the screening decision with my doctor rather than slink out the door with my questions unanswered. An online decision tool that launched earlier this year may make that conversation easier.

The online tool, called Breast Screening Decisions, grew out of a blog post written by Margaret Polaneczky, a gynecologist at Weill Cornell Medical College, back in 2009. That's when the U.S. Preventive Services Task Force first recommended that average-risk women in their 40s shouldn't be automatically be screened for breast cancer. (The task force is currently updating those recommendations, though the draft released earlier this year sticks to that same basic message.)

"I found myself really wondering how I'd address this in my practice," says Polaneczky. So she dug into the data used by the USPSTF and wrote about the controversy. In short, mammograms starting at 40 do save lives across a population of women, but not many, and at the cost of false positive results and the overdiagnosis of breast cancers that never would have threatened a woman's life if left undetected.

Polaneczky got good feedback on her explanation and wanted to help women and their physicians sort all this out with some kind of evidence-based screening decision aid. "I wanted women to decide not as a gut reaction to a horror story they've heard, either pro or con," she says.

There are plenty of online tools to calculate risk, but Polaneczky wanted to also give an estimate of the effects of screening and help women think about their own values.

She collaborated with Elena Elkin, a health outcomes researcher at Memorial Sloan Kettering Cancer Center. "We wanted this to be based on the best available evidence on mammography, and to use the best ways to communicate with people about risk," says Elkin. The tool is based on the data the USPSTF used to formulate its 2009 recommendations, which is a mix of information from large registries, analyses of the many studies done of mammography and predictive models.

The tool gives a woman in her 40s (it's not meant for older or younger women) an individual breast cancer risk assessment by asking questions about ethnicity, age at first menstrual period, personal history of breast abnormalities and family medical history, among other factors. Then it uses easy-to-understand infographics to show what is likely to happen across a population of similar-risk women if they have regular mammograms.

For example, after providing my own information, I learned I was at low to average risk of breast cancer, with a five-year risk of developing the disease at 0.9 percent. Or put another way, nine of 1,000 women like me will develop breast cancer in that time period.

I learned that if 1,000 low-to-average-risk women of my age have a mammogram, 900 will get a normal result, though one of them will actually have breast cancer that is missed by the test. The other 100 will have an abnormal mammogram that requires further testing or biopsies, but only two of them will actually have breast cancer.

What I found most illuminating were the scenarios for starting mammograms at different ages and intervals. If 1,000 women of my age and risk profile have annual mammograms starting at 40, over a lifetime, 22 will die of breast cancer. On the other end of the spectrum, if those women start mammography at age 50 and are screened every other year, 25 will die of breast cancer. That's not a big difference — unless of course, you or someone you care about is among those three additional deaths.

My tour of the tool ended with a series of questions intended to clarify what's important to me. For example, am I willing to do anything to detect breast cancer as early as possible? How worried am I about the harms of screening? (The tool provides information about unnecessary biopsies or overdiagnosis, but doesn't quantify them because the exact numbers are controversial, says Elkin.)

Those values questions are important, say the tool's creators. "Some women will say, 'My mother had a breast biopsy and developed an abscess, and I never want an unnecessary biopsy,' " says Polaneczky. "Another will say, 'My mother had breast cancer at 45 and I will do anything to catch it early.' "

Unpublished data show that most initial users of the tool came away with an accurate gauge of their risk and of the benefits and limitations of screening. Deanna Attai, assistant clinical professor of surgery at UCLA's David Geffen School of Medicine, says she recommends the decision aid to her patients. Given a doctor's limited time, it's nice to have something women can complete on their own, then bring in for discussion, says Attai, who is also the president of the American Society of Breast Surgeons. (The group recently revised its own mammography consensus statement.)

Shots - Health News OK, When Am I Supposed To Get A Mammogram?

Doctors know they're supposed to having this kind of conversation with their patients, says Christine Gunn, a research assistant professor at the Boston University School of Medicine. But "how that looks in practice hasn't been spelled out," and clinicians tell her they don't always know what to do, she says. Her own research has shown that just 31 percent of women under 50 feel they are being given a choice to undergo screening.

The creators of the decision aid say their aim isn't to drive women toward or away from mammography, but to help them make an informed choice. "The mere fact that there's inconsistency should tell us that not even the experts agree on the best thing for an individual to do," says Elkin. When a woman makes her choice, "we should respect that," she says.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: @katherinehobson

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Pitching Health Care In Baltimore's Red Light District

NPR Health Blog - Tue, 11/10/2015 - 3:59pm
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Nathan Fields talks to passersby about how to use a naloxone auto-injector to treat an opioid overdose.

Meredith Rizzo/NPR

Every Thursday night you can find Nathan Fields making the rounds of Baltimore's red light district, known to locals as The Block.

An outreach worker with the Baltimore City Health Department, Fields, 55, is a welcome sight outside strip clubs like Circus, Club Harem and Jewel Box.

In the early evening before the clubs get busy, he talks with dancers, bouncers and anyone else passing by about preventing drug overdoses and how to stop the spread of HIV and other sexually transmitted diseases.

Later on, he'll drop into the clubs to check on the dancers who aren't able to come outside, finding out what they might need.

Fields has credibility on The Block that people higher up in the health department don't. "I watch him walk down any street in Baltimore city, and people come up to him, and they know that he is there to serve them," says his boss, Health Commissioner Dr. Leana Wen.

The needle exchange van parks on the corner of a block that is home to numerous strip clubs.

Meredith Rizzo/NPR

It wasn't always so easy.

Seven years ago, Fields was working with the city's needle exchange program. After a spate of drug overdoses at the strip clubs, the health department brought its needle exchange van to The Block one night a week.

There were hardly any takers at first. People were skeptical.

"They were under the impression that we were giving their information to the police," Fields says. "So that's when I came on board. You know, I'm a great negotiator. Donald Trump can't beat me out."

Fields started with the bouncers. Though a Baltimore native, Fields is a huge fan of the New England Patriots and would often show up in head-to-toe Pats gear. The Baltimore Ravens-loving bouncers hated his get-up, and the football rivalry broke the ice.

Seven years ago, Fields began outreach work with Baltimore's needle exchange program on The Block.

Meredith Rizzo/NPR

Eventually, the sports talk turned more personal. Fields learned that some of the men had girlfriends dancing in the clubs who needed help – everything from condoms to drug treatment. Some women needed copies of birth certificates and other forms of ID in order to get into treatment.

Fields leaned on colleagues in the health department to get the problems solved.

Soon, the clubs doors opened for him. Once inside, Fields saw people needed even more.

"We went into one club, and there were three girls in different stages of pregnancy that were still dancing," he recalls. "We started running it up the chain: 'Hey, we need health care down here — reproductive health care.' "

So in addition to the needle exchange van, the city brought a second van to The Block, one with an exam table and a nurse. Now, every Thursday night, health workers offer needles for exchange, training in the anti-overdose drug naloxone, HIV tests, reproductive health exams, pregnancy tests, flu shots and more other basic health care services.

(Left) A Baltimore City health worker demonstrates how to use a naloxone auto-injector. (Right) Inside the needle exchange van, bundles of used needles are held in a container for disposal.

Meredith Rizzo/NPR

Fields treats each person coming into the vans like family. He remembers babies and boyfriends and other small details of people's lives.

"The Block is like living," he says. "These relationships, you've got to keep them flourishing."

Quietly, Fields also hands out pamphlets with information about drug treatment. Every so often, he'll mention a new option and encourage someone to check it out. But, it's a soft sell. He doesn't want to drive people away.

"I don't beat a person over the head," he says. "I never badger anybody for fear of them looking at me like, 'Oh, he's an elitist. He forgot where he came from.' I could never forget where I come from."

Nathan Fields (center) with his sons Hassan Fields (left) and Malik Fields on Friday, May 22. Hassan was shot and killed that weekend.

Courtesy of Nathan Fields

For nearly 20 years, Fields was a heroin addict. He sold drugs to support his habit and did time in the Baltimore City jail. "I was a predator to my community," he says.

After getting clean in the mid-1990s, he got a job as a recovery counselor. In 2004, he went to work with the Baltimore City Health Department. "The job just gives me a sense that I'm helping to build back what I tore down," he says. "You know, every time I can get somebody to even thinking different or even consider going into treatment, I feel as though I had a successful day."

In spite of those small victories, it's been a particularly difficult year for Baltimore and for Nathan Fields.

Over Memorial Day weekend, the outbreak of violence following the death of Freddie Gray claimed the life of his youngest child, 20-year-old Hassan Fields. He was shot and killed on the west side of Baltimore. His death remains an open case.

Nathan Fields struggles to understand how this could happen to him, given all he's done for the community. He had thoughts of reverting to the person he once was. Then, he came to a quieter place.

"The Block is like living," outreach worker Nathan Fields says. "These relationships, you've got to keep them flourishing."

Meredith Rizzo/NPR

"I'm sorry. I can't let this destroy me," he says. "I can't let this turn what my thoughts are about human nature — some good people with some bad people. I believe the bad people have a little bit of good in them too. It's just got to come out."

Thinking about Hassan's death has led him to reflect on his own past.

"I just have to look back on myself and say, I've caused pain. No, I've never done anything as violent as that, but I've got to keep working. I can cherish his memory, I sit down, I look at his picture and think about it, and it just makes me work harder."

NPR and All Things Considered will continue reporting from Baltimore in the coming months, checking in with Leana Wen and her team. Stay tuned for future stories.

Copyright 2015 NPR. To see more, visit
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Some Hospital Systems Want To Care For You And Sell You Insurance

NPR Health Blog - Tue, 11/10/2015 - 12:27pm

Geisinger Health System, based in Danville, Pa., offers both insurance and patient care.

Bradley C. Bower/Reuters/Landov

In addition to treating what ails you, a number of health care systems aim to sell you health insurance to pay for it.

Some of the most competitively priced policies on health insurance marketplaces are offered by the providers of health care, but it remains to be seen how many health systems will succeed over the long haul as insurers.

It's not surprising that health systems might get into the insurance business. Doing so funnels more patients to a health system's hospitals and doctors. And it makes sense that combining clinical and claims data under one roof could lead to better coordinated, more cost-efficient patient care.

A number of well-regarded health systems have long sponsored insurance plans, including Kaiser Permanente, headquartered in Oakland, Calif., Geisinger Health System in central Pennsylvania and Intermountain Healthcare in Utah. (Kaiser Health News, an independent service of the nonprofit Kaiser Family Foundation, is not affiliated with the health insurance company Kaiser Permanente.)

Yet even though health care systems can gain insurance know-how by partnering with or acquiring an insurer or third-party administrator to handle claims, compliance and customer service, putting it all together can be challenging.

"They're inexperienced," says Gunjan Khanna, a partner in the health care practice at McKinsey & Co. who co-authored a paper on this type of plan, when talking about newer entrants in this market. "The viability of that business and the ability to manage that is a question." For example, it may take years to develop the necessary skills in managing financial risk and coordinating patient care beyond the hospital or clinic, among other things.

Health plans sponsored by providers are still rare. In 2014, 13 percent of health care systems in the United States offered plans that covered 18 million members, or about 8 percent of all people with insurance, according to McKinsey. Most of the people covered by provider-led plans are in Medicaid managed care or Medicare Advantage plans.

A growing number of provider-led plans are available on the health insurance marketplaces. When the marketplaces opened in 2014, there were 64 provider-led plans; next year there will be 72, according to McKinsey. In 2016, 19 percent of the new carriers on the exchanges will be provider-led plans.

The provider-led marketplace plans are priced very competitively, says John Holahan, a fellow at the Urban Institute's Health Policy Center. In a number of rating areas, the plans will be the lowest priced at the silver level in 2016, according to a forthcoming analysis of 63 rating regions in 21 states, Holahan says. The lowest priced silver plans include those sponsored by New York's North Shore-LIJ Health System, Oregon's Providence Health and Services and Inova Health System in Virginia.

Network coverage in these plans varies. Some cover only services within the health system, while others offer broader access.

Consumers have generally been willing to accept narrower networks of hospitals and doctors in exchange for lower premiums.

"The exchanges have pushed the concept of narrow networks front and center," says Khanna. Consumers confronting that might want to "consider a provider health plan, because it's based around a network of providers and at heart a network is built around a health care system."

Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. Email questions: Michelle Andrews is on Twitter: @mandrews110

Copyright 2015 Kaiser Health News. To see more, visit
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More Women Opt For IUD, Contraceptive Implant For Birth Control

NPR Health Blog - Tue, 11/10/2015 - 12:03am

Birth control pills are 99 percent effective in preventing pregnancy, research shows — but only if you remember to take them as prescribed. Rod-shaped implants, T-shaped IUDs and vaginal rings are other options.

BSIP/Science Source

Contraceptive implants and IUDs are very effective in preventing pregnancy — nearly 100 percent, statistics show. A new federal survey finds many more women are making this choice than did a decade ago.

Federal researchers analyzed data from a national health survey that included birth control practices among women of childbearing age. The survey found that while use of the pill, condoms and female sterilization all dipped between 2002 and 2013, the number of women using long-acting contraception more than quadrupled. These days, 11.6 percent of U.S. women — 4.4 million — rely on either an intrauterine device or a contraceptive implant to prevent pregnancy.

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IUDs come in two types. One is made of plastic and copper. The other kind, made of plastic, releases a progestin hormone.

The contraceptive implant works by releasing progestin delivered via a small, flexible tube inserted under the skin, usually in the woman's upper arm.

Both IUDs and implants are reliable for years without intervention or replacement, doctors say, and that's key to their efficacy and popularity. The implant prevents pregnancy for three years and the IUDs for three to 12 years, depending on the type, says Megan Kavanaugh, senior research scientist at the Guttmacher Institute. The pill is also highly effective, when taken as prescribed every day, she says, but you have to remember to take it.

Kavanaugh says the methods are endorsed as good options by medical associations, and more and more providers are being trained in how to insert them, which may have contributed to the uptick in use. Also, in plans established under the Affordable Care Act, insurance companies are required to cover birth control methods, including inserting IUDs and implants, she says. And that could increase their popularity.

As part of her own research on why women choose one method of birth control over another, Kavanaugh interviewed teenagers and young 20-somethings. Many, she says, told her, "I have so much on my plate — and I can't remember to take a pill every day." For this age group in particular, Kavanaugh says, these long-lasting methods are very reasonable options. They're the most effective methods available, she adds, "similar to sterilization" in effectiveness.

Unlike sterilization, the IUD and implant are both reversible and can be stopped at any time — also an important consideration for many people.

"We just want to have as broad a mix as possible for all women," Kavanaugh says, "so they can choose the birth control method that works best for them."

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Aggressive Lowering Of Blood Pressure Carries Risks As Well As Benefits

NPR Health Blog - Mon, 11/09/2015 - 4:19pm

For people 50 and older at a high risk for heart disease or stroke, an aggressive approach to treatment has advantages. But there are risks, too.


In early September, the National Institutes of Health halted a study that aimed to figure out the right blood pressure goal for people with hypertension and other risks for heart disease and stroke.

The accepted target has been to get patients' systolic pressure (the first number in the pair used to gauge blood pressure) below 140. This study tested whether lowering systolic pressure below 120 would be a better idea.

A year before the study of more than 9,000 people age 50 and older was scheduled to end, the results already showed a big difference in health between patients whose doctors aimed to get below 120 rather than 140. Fewer people died in the more aggressively treated group, too. (People with diabetes, a risk factor for cardiovascular disease, were excluded from the study, called SPRINT for short.)

Reducing systolic blood pressure below 120 reduced heart attacks, heart failure and strokes by nearly a third and the risk of death by almost a quarter, a press release announcing the decision said.

But the details were missing. What about side effects? How big a difference, in absolute terms, did the more intensive approach make?

On Monday, the detailed results were presented at the American Heart Association annual scientific meeting in Orlando, Fla., and published online by the New England Journal of Medicine.

For people in the group whose blood pressure goal was lower than 120, the annual rate for a serious cardiovascular event — including a heart attack, stroke, heart failure or death from cardiovascular causes— was 1.65 percent. For the group whose blood pressure target was less than 140, the rate was 2.19 percent, 0.54 higher than the more aggressive approach.

In relative terms, the group that got treated more aggressively did 25 percent better than the one that was treated according to the traditional goal.

"It's a great study that provides evidence that some people should consider a lower target blood pressure than has been previously recommended," Yale cardiologist Harlan Krumholz and occasional Shots contributor said in an email. "But there are lots of caveats and people should not panic if their blood pressure is above 120."

For instance, there was a greater risk of side effects from treatment for people who received the intensive treatment, some of them serious. Among the problems were blood pressure that was too low (3.4 percent for the intensive group vs. 2.0 percent for standard treatment), fainting (3.5 percent vs. 2.4 percent) and acute kidney injury or failure (4.4 percent vs. 2.6 percent).

The NIH's September press release didn't include information about side effects.

"The thing about risk factors like hypertension is that not everyone who gets treated gets a benefit," Krumholz cautioned. "It is about whether you lower risks enough to make it worth it — and whether the adverse effects are not important enough to you to deter you."

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Menopause: A Gold Mine For Marketers, Fewer Payoffs For Women

NPR Health Blog - Mon, 11/09/2015 - 3:13pm
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Diane Bigda/Getty Images/Illustration Works

Over the years, many of us women have heard or used lots of euphemisms to describe menstruation:

My Friend.

The Curse.

Aunt Flo.

The Crimson Tide. (Yeah, sorry, Alabama, but that preceded you.)

But code words for menopause? Not so much. Menopause was a process that was shrouded in mystery, myth and misinformation. Somehow, the reversal of menstruation, tied as it was to women's aging, was viewed as just shameful. Icky.

Which is strange, considering that women make up 51 percent of the earth's population. And that barring something extraordinary, they will all go through menopause.

Despite that — crickets.

There have been a few notable exceptions. Menopause showed up on hit sitcoms All in the Family and The Cosby Show. There was a cheeky off-Broadway production, Menopause — the Musical!

And a few female comedians like Karen Mills and Chonda Pierce have decided to talk about menopause out loud. In public.

In general, they did a better job of lampooning the process than their male peers. Maybe because they knew what they were talking about. (Or maybe women are just funnier?)


But it took a World War II hero who just happened to be the former majority leader of the United States Senate to move the meno-conversation further along.

"You know, it's a little embarrassing to talk about ED," Bob Dole confessed to TV viewers way back in 1988. "But it's so important to men and their partners that I decided to talk about it publicly."

That ad for Viagra, often referred to as the Little Blue Pill, helped to remove the stigma from erectile dysfunction and cracked the door open for more people to have honest conversations about how their aging bodies worked. It did wonders for men with ED. It's taking a lot longer for a public conversation about menopause.

For one thing, we're still learning about it. When Dr. Wulf Utian, a founder of the North American Menopause Society, started to research menopause back in 1967 at the University of South Africa, he said there was one line about menopause in his medical textbooks. One.

"It said, 'Menopause is physiological amenorrhea' — which means it's the normal loss of periods and there's nothing else to say about it," Utian remembers.

But menopause is more than the just reverse of menstruation. It's actually a systemic change to the body: In addition to those infamous hot flashes, many women experience what they describe as "brain fog" — forgetfulness or disorientation. Most find they're gaining weight, especially around the middle. There may be mood swings. Libido can plunge, and even when it doesn't, vaginal dryness can make it painful.


Fun stuff.

But a lot of women now experiencing menopause are part of the second-wave feminists who helped launch the sexual revolution. Their bible was Our Bodies, Ourselves, the groundbreaking handbook by the Boston Women's Health Collective that urged women to research, question and press for answers: "if this doesn't work, what about that? What are the side effects?"

And they want some of this stuff fixed. Which is why you're starting to see more ads for menopause-related products, many of them for conditions you didn't know had names. That drop of urine that escapes many women during a laugh or sneeze is now being labeled LBL — Light Bladder Leakage. And yep, there are multiple products sold for that, including pads, a tamponlike product called Poise Impressa and prescription medications.

Dr. Hilda Hutcherson remembers her mother and friends whispering among themselves about their menopause symptoms at girls-only gatherings. But those were private conversations with good friends.

Fast-forward to now: Hutcherson, an OB/GYN who teaches at Columbia University's College of Medicine in New York, and her girlfriends don't relegate The Talk to a closed-door room. "My girlfriends and I talk about it all the time," Hutcherson says. "We compare notes: How are you dealing with your hot flashes, and how are you dealing with your desire? It's so much easier to talk about all of those things now."


Partly because Dole's Viagra confessional broke the ice. And partly because, Hutcherson says, women of her generation assume they can — and should — be partners with their doctors in their health care. They did it with birth control. And now they want to do it with menopause. So they're researching, comparing notes and pressing their doctors about how to deal with some of the more uncomfortable aspects of menopause.

"Women are saying, 'I don't have to live with it. I see the commercials on TV, I'm reading about it in the magazines and online, and I know that I don't have to accept this, that there are things that can make my sex life, and my life in general, better,' " Hutcherson says.

Those commercials can be a two-edged sword, though.

Dr. Janet Pregler, director of the Iris Cantor UCLA Women's Health Center, thinks that a more open attitude about menopause is a great thing, but menopause marketing can be complicated. On one hand, if it raises awareness and gets women who think they have a problem to go in to be checked out, that's good. Especially if there is something that can mitigate their discomfort.

"Many of these things [being advertised] are important, and do give relief to a small number of women," Pregler says. "The issue has been, obviously ... that health care industry is an industry, and there's been this sense of 'OK, well let's sell this to as many people as we can.' "

Which, she says, leads some women who are managing their menopause just fine to wonder if they're missing something.

"I've actually had patients come in and say, 'I think there's something wrong with me — I'm not having terrible menopause symptoms, and aren't I supposed to have those?' " Pregler says.

One would certainly think so, given the proliferation of ads for everything from hot flashes to waist-level weight gain (sometimes sardonically labeled the menopot), to dryness that makes intimacy painful, maybe even impossible. There's a supposed remedy for every complaint.

And therein lies the problem, says Utian. Companies have realized that there is big money to be made from a baby boomer demographic in full menopausal flush. In many instances, he says, we're looking at "multibillion-dollar markets." So there are lots and lots of ads that target women in menopause — some legitimate, he says, most not.

In September, the North American Menopause Society issued a report on what works and what doesn't for hot flashes and other symptoms. Aside from hormone therapy, the doctors said there's evidence of benefit for just two treatments — cognitive behavioral therapy and clinical hypnosis. They also said that SSRI antidepressants may help, but over-the-counter and herbal remedies do not.

Utian says the former reluctance to mention menopause has given way to a very different attitude. "Instead of women whispering the word 'menopause,' " as they did a couple of generations earlier, "the word is everywhere now." And as a result, "there's a whole cohort of organizations and snake oil salesmen and so on all trying to climb in on the bandwagon."

The challenge for women in menopause is how to separate the snake oil from what really works, safely and reliably.

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It's Never Too Soon To Plan Your 'Driving Retirement'

NPR Health Blog - Mon, 11/09/2015 - 4:36am
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At 72, Robert McSherry says he's not yet ready to quit driving or ready to plan how he'll get around when that time arrives. But he's happy to get the insurance discount that comes with taking a driver safety class.

John Daley/Colorado Public Radio

Harriet Kelly has one word to describe the day she stopped driving four years ago: miserable.

"It's no fun when you give up driving," she says. "I just have to say that."

Kelly, who lives in Denver, says she was in her 80s when she noticed her eyesight declining. She got anxious driving on the highway, so decided to stop before her kids made the move for her.

"I just told them I'd stop driving on my birthday — my 90th birthday — and I did. And I was mad at myself because I did it," she says, laughing. "I thought I was still pretty good!"

Kelly is now 94. She says her last traffic accident was in the 1960s. But, she says, "I think it's just better to make up your own mind than have your kids go through trying to tell you, and end up with arguments and threats and everybody gets mad."

Her daughter Leslie Kelly says she's grateful she and her siblings didn't have to have that tough conversation. Still, she knows it's been tough for her mom.

Harriet Kelly of Denver says she hasn't had even a fender bender since the 1960s. Still, she noticed in her 80s that her eyesight was starting to decline. She made a plan to stop driving at 90 — and did just that.

John Daley/Colorado Public Radio

"It really cut down on her ability to feel independent," says Leslie. Harriet chimes in, "It certainly did!"

But Harriet Kelly is a great example of someone who planned for her "driving retirement," says Dr. Emmy Betz, an emergency medicine specialist who does research at the University of Colorado School of Medicine on the safety of older drivers.

"Retirement is something that happens to all of us," Betz says. "Maybe we even look forward to it. You prepare for it, you make financial plans, you think about what you're going to do."

But most seniors don't do that when it comes to driving, she says.

"It's sort of the elephant in the room that no one wants to talk about, but it's an issue that's coming for most of us and our family members and so denial isn't probably the most helpful option," she says.

"Transportation is a huge issue that we need to address," says Jayla Sanchez-Warren, director of the Area Agency on Aging for the Denver Regional Council of Governments. For seniors, she says, a lack of transportation also "contributes to so many other things — like poor health care outcomes, isolation and depression."

A recent report by researchers at Columbia University and the AAA Foundation for Traffic Safety found that older adults who give up driving are nearly twice as likely to suffer depression as those who stay behind the wheel.

In my family, we've had to have that conversation twice. When my dad talked to my grandmother, she hid another set of keys, and drove secretly until they found out. Then, 30 years later, "hell" and "no" were just two of the choice words that erupted from my dad when his Alzheimer's diagnosis led us to insist that he stop driving.

Betz urges families to plan ahead, talk about it years before it happens and map out transportation alternatives.

"Imagine if I told you to give me your keys," she says. "And you can no longer drive, starting right now. I mean, what would you do? It's totally unrealistic that we think that that's an OK thing to do to older people."

It will become an issue for lots of us and our families. Nationally, until 2030, roughly 10,000 baby boomers will turn 65 each day, according to the Pew Research Center.

In many cases, drivers age 50 and older can get a discount on their car insurance by taking a driver safety class.

At a senior center in a suburb of Denver, Chris Loffredo teaches just such a class. She asks the 20 attendees to think about everything from how medications might affect them to how new technologies in cars may help them. And, she wants them to strategize.

"You have to know when to give up your keys!" she tells them.

But not a hand goes up when the group is asked if they're ready to talk about that. After the class, retirees Ralph Bunge, who is 72, and his wife, Paula, who is 67, say they're not ready.

"The conversation wouldn't be as difficult as doing it would be," laughs Ralph. Paula agrees.

Driver safety classes, like this one offered by AARP in Aurora, Colo., include discussion of ways to minimize blind spots and the effects of medication on driving, along with a review of road rules.

John Daley/Colorado Public Radio

"We're just not really at a place where we imagine that that decision is going to be made any time soon," she says.

Robert McSherry, who is 72 and retired, says for now he's in denial.

"One thinks, well, that you'll live forever," McSherry says.

Harriet Kelly says she's made adjustments since giving up the keys four years ago. She now hires a companion or calls Uber to take her on errands. She also gets rides from friends, but adds that there are "fewer and fewer people that I'll drive with in their 80s."

In fact, scientific studies show that if older drivers present a danger, it's mostly to themselves and their passengers, Betz says. Fatal crash rates are higher for older drivers, she says, but that's mostly because they don't heal as well after a crash.

This story is part of NPR's reporting partnership with Colorado Public Radio and Kaiser Health News.

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Hormones May Help Younger Women With Menopause Symptoms

NPR Health Blog - Mon, 11/09/2015 - 4:35am
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For Linnea Duvall, a marriage and family therapist who lives and works in Santa Monica, Calif., the symptoms of menopause started when she turned 50. She felt more irritable and a smidge heavier, and she started waking up two to three times a night.

And then she had a hot flash.

"It felt like a nuclear bomb went off right behind my belly button," she says. "The radiation went out to my fingertips, the tops of my toes, the top of my head and the ends of my hair."

But Duvall would not consider hormone therapy to control the flashes. She was terrified. She says she can sum up her fear in two words: "breast cancer."

To understand why she feels this way, we have to look back a few decades to a time when many postmenopausal women were taking hormones to treat symptoms. At the time, hormones were thought of as something of an elixir of youth that could also prevent chronic disease. So women took hormones indefinitely. But a huge study in 2002 changed everything.

Known as the Women's Health Initiative, it found that taking estrogen plus progestin hormone replacement therapy actually increased a woman's risk of heart disease and breast cancer. The study had a huge effect. Within months the number of women taking hormones in the U.S. dropped by almost half. Today, only about 10 percent of women ages 50 and over are on hormone therapy.

That was a huge overreaction, according to Dr. Wulf Utian, director of the North American Menopause Society, particularly in light of more recent findings. A more detailed analysis of the Women's Health Initiative data found that age really made a difference in heart disease risk. For women who started hormone therapy between the ages of 50 and 59, there was a protective benefit, says Dr. JoAnn Manson, one of the lead investigators of the study and a professor of medicine at the Harvard T.H. Chan School of Public Health.

Women who take hormones earlier after the onset of menopause may experience less plaque, blood vessel blockage and atherosclerosis, Manson says, and possibly even a reduced risk of heart attack. But for women over the age of 60, the benefit seems to disappear. This is probably because older women already have plaque buildup, Manson says.

Researchers in Denmark also found that age makes a difference. They looked at 1,000 healthy women between the ages of 45 and 58. The women who took hormones experienced significantly reduced risk of mortality, heart failure and heart attack.

Today, menopausal women are young in the scale of things, says Dr. Utian, noting that menopause typically starts between age 45 and 60. If women start hormones within a few years of menopause or even a few years before, he says, there are numerous benefits beyond controlling hot flashes. These benefits include reduced risk of bone fractures, reduced risk of diabetes and, for many women, an overall boost in their quality of life — meaning better sleep, maintenance of libido and more comfortable sex.

"In my opinion, the best recommendation would be for some form of hormone therapy," says Utian.

But here's the worry. Studies do confirm an increased risk of breast cancer among women taking hormones, regardless of age. Manson says any risk is worrisome, but it's important to put this risk in perspective and understand that it is actually small.

"For every 1,000 women per year not using hormone therapy, about three would develop breast cancer," Manson says. "And among every 1,000 women using hormone therapy, about four of them would develop breast cancer, so that's about one extra case of breast cancer per 1,000 women per year on hormone therapy."

This is where things get tricky. There is no consensus in the medical community on whether the symptom relief is worth the extra risk. Different doctors interpret risk differently. And if you're a breast oncologist like Dr. Rowan Chlebowski at Harbor UCLA Medical Center, any risk is too much.

"It's a disease that I see every day," Chlebowsi says. "So I think that's something to be avoided."

Chlebowski adds that hormone therapy also makes it more difficult to read mammograms, since hormones make the breast denser. If mammograms are more difficult to read, it's harder to diagnose breast cancer in its earliest stage when it's most treatable.

So bottom line — this really is an individual decision between a woman and her doctor, a decision based on how much risk a woman can tolerate in favor of symptom control and other potential benefits. Researcher Joann Manson says if a woman chooses hormone therapy, then the lowest possible dose for the shortest amount of time is probably safe for most women.

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Confusion And High Costs Still Hamper Obamacare Enrollment

NPR Health Blog - Sat, 11/07/2015 - 6:21am
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Vernon Thomas, a part-time music producer, is trying to decide whether it's worth it to sign up for health insurance.

Fred Mogul/WNYC

Recording and mixing music are Vernon Thomas' passions, but being CEO and producer of Mantree Records isn't his day job.

He's an HIV outreach worker for a county health department outside Newark, N.J. He took what was to be a full-time job in May because the gig came with health insurance — and he has HIV himself.

But then the county made it a part-time job, and Thomas lost health coverage before it even started. "Benefits are more important than the money you're making," he says.

The Affordable Care Act's third open enrollment season started Nov. 1, and federal officials are hoping to reach about a million uninsured people nationwide before it closes on Jan. 31.

Newark has an estimated 112,000 uninsured people, including Thomas, around one-third of the city's population. Newark is one of five areas – along with Houston, Dallas, Chicago and Miami – where the federal government is focusing enrollment efforts.

Altogether, Washington will spend more than $100 million dollars on marketing and enrollment nationwide.

Why has Thomas stayed on the sidelines for Obamacare's first two years? He values insurance and regular health care, but he says he didn't fully understand what the law had to offer him. He's still trying to make up his mind about signing up for coverage this time around.

He has been getting HIV medications, care of the federal government's AIDS Drug Assistance Program. It doesn't cover anything else, though, and Thomas says he'd like more medical care, particularly a regular doctor who could keep an eye on issues that worry him.

"Prostate cancer runs in my family on both sides," Thomas says. "My mother and her mother and her brother all had diabetes. My mother had hypertension also. Fortunately, I have low blood pressure. But now they're saying I have high cholesterol."

Thomas' part-time job doesn't pay a lot, yet he makes too much to get free health care from Medicaid. He's eligible to buy a plan on the exchange, but he says it's too expensive because the cost of living in Newark is high for him.

So he has gone without coverage and kept his fingers crossed. "I try not to think about it — getting sick," he says.

Thomas didn't know the health law's benefits for people in his income bracket. He qualifies for subsidies that would bring his premium down to $100 or less and also cost-sharing support that would pick up much of the deductible and other out-of-pocket expenses.

Brian McGovern, head of the North Jersey Community Research Initiative, says overcoming misconceptions about Obamacare has been one of his staff's biggest jobs. "It's always been about trust with some of our patients," he says.

Susan Nash, a partner at the McDermott Will & Emery law firm in Chicago, says that health insurance is still too expensive for millions of people living paycheck-to-paycheck.

"These individuals are having difficulty affording food and housing, and so it's a calculus: 'Do I need health insurance? Do I think I'm going to have a catastrophic event or have some large health care expenditures this year?' " Nash says.

The government says about 8 in 10 of these eligible but uninsured people qualify for subsidies. But some of them will get only a little help from the government — and others will get none at all.

Middle-income people can spend hundreds of dollars a month on a high deductible, if they need significant care. And they wouldn't qualify for the same help with out-of-pocket expenses that Vernon Thomas would. That means they often spend additional hundreds of dollars before coverage actually kicks in.

Still, under the law, most people have to get insurance – or face a tax penalty next year of either 2.5 percent of income or $695 per adult and $347.50 per child under 18, with a maximum of $2,085. Even if people have a sense of these fines, they still might not worry about it. The fines don't actually hit until Tax Day, 2017. And for many of people, that's just too far away – and just too abstract.

This story is part of a reporting partnership that includes WNYC, NPR and Kaiser Health News.

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Surgery Helps Some Obese Teens In Battle To Get Fit

NPR Health Blog - Fri, 11/06/2015 - 3:11pm
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Physical exercise, diet and supportive counseling are the first steps of any weight-loss program. But sometimes that's not enough to take large amounts of weight off, and keep it off, doctors say.


Surgery to reduce the stomach's size is often seen as a last resort for severely obese teenagers, partly because there has been little information on the procedure's long-term effects on young people.

But a study published online Friday in the New England Journal of Medicine tracked teens for three years and suggests that bariatric surgery as part of a weight-reduction plan was not only safe, but increased their heart health and the quality of their lives.

Dr. Thomas Inge, a surgeon at Cincinnati Children's Hospital Medical Center, led the study of 242 severely obese adolescents who underwent the surgery.

The young people were between 13 and 19 years old and averaged 325 pounds at the start of the study, Inge says. Surgery helped them lose nearly a third of their original body weight and maintain that loss for three years. Even more importantly, Inge says, the development of obesity-linked disease was stopped in its tracks.

Of teens who had Type 2 diabetes when they underwent the surgery, "95 percent of them had no sign of diabetes at three years," Inge says. Most participants in the study also dramatically reduced their blood pressure after surgery, and had improved kidney function and less blood fat.

The hope is that these sorts of improvements in physical markers will ultimately translate to fewer strokes, heart attacks and other disabilities down the road, he says. Previous research has suggested that only about 2 percent of severely obese teens are able to lose weight and keep it off without surgery.

Adults who have weight-loss surgery also see reductions in diabetes, blood pressure and blood fat, Inge says. But the improvements aren't as dramatic — perhaps, he says, because it's easier to tame a disease that hasn't already had years to do damage.

The teens also experienced a big jump in their confidence.

"I think it's one thing to talk about what this does to their blood pressure and diabetes," Inge says. "It's a whole other thing, when you're in the patients' shoes, to be able to talk about how they feel after the operation."

The answer, he says, was unmistakably good — so good that some kids made a few other bold changes in their appearance, taking deliberate steps to stand out instead of trying to hide.

"It's very much the routine to see them expressing themselves and saying, 'Here's me with green hair color, pink hair color," Inge says. "It's telling the world, 'This is the new me, and I like it!' And, 'Here we are!' "

The surgery isn't without side effects and these, too, showed up in the study. In addition to the risks of any surgery, bariatric surgery alters how the body digests food — so most of the teens also had to start taking vitamin and iron supplements after the procedure. And about 13 percent wound up needing additional abdominal surgery — most commonly gall bladder removal.

These teenagers and others need continued follow-up to be certain that benefits outweigh risks as the years go on, Inge says. But at least now, teens — and their parents and doctors — are starting to get a little more solid information to help guide choices about treatment.

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Did The Language You Speak Evolve Because Of The Heat?

NPR Health Blog - Fri, 11/06/2015 - 11:51am

English bursts with consonants. We have words that string one after another, like angst, diphthong and catchphrase. But other languages keep more vowels and open sounds. And that variability might be because they evolved in different habitats.

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Consonant-heavy syllables don't carry very well in places like windy mountain ranges or dense rainforests, researchers say. "If you have a lot of tree cover, for example, [sound] will reflect off the surface of leaves and trunks. That will break up the coherence of the transmitted sound," says Ian Maddieson, a linguist at the University of New Mexico.

That can be a real problem for complicated consonant-rich sounds like "spl" in "splice" because of the series of high-frequency noises. In this case, there's a hiss, a sudden stop and then a pop. Where a simple, steady vowel sound like "e" or "a" can cut through thick foliage or the cacophony of wildlife, these consonant-heavy sounds tend to get scrambled.

Hot climates might wreck a word's coherence as well, since sunny days create pockets of warm air that can punch into a sound wave. "You disrupt the way it was originally produced, and it becomes much harder to recognize what sound it was," Maddieson says. "In a more open, temperate landscape, prairies in the Midwest of the United States [or in Georgia] for example, you wouldn't have that. So the sound would be transmitted with fewer modifications."

A sample of Georgian from the UCLA Phonetics Lab

Other scientists have noticed that habitats can affect the way different bird species sing. "Say you're a bird in a forest, and some guy's going 'Stree! Stree! Stree!' But because of the environment, what you hear is 'Ree! Ree! Ree!' " says Tecumseh Fitch, a linguist at the University of Vienna in Austria who was not involved in the study. "Well, because you're learning the song, you'll sing 'Ree! Ree! Ree!' "

Since bird species living in rain forests tend to sing songs with fewer consonant-like sounds, Maddieson thought maybe the same would apply to human languages. Over time, people living in different climates would adapt their speech to communicate more efficiently.

In a presentation on Wednesday at the Acoustical Society of America fall meeting, Maddieson showed that consonant-thick languages like Georgian are more likely to develop in open, temperate environments. Meanwhile, consonant-light languages like Hawaiian are more likely to be found in lush, hot ecologies.

A sample from Oiwi TV, Hawaiian language news

A vowel sound like "e" can still sound clear through the dense vegetation in Hawaii.

Daniel Ramirez/Flickr

Fitch says it's a tantalizing hypothesis, but still unproven. People who live nearby are usually related, so their languages could be too. Hawaiian and Maori are light on consonants and developed in hot, tropical climates, but they also both came from an ancestor Eastern Polynesian language. That could confound the results of Maddieson's study. Until that's sorted out, Fitch says, it's hard to know how strong the data are.

And the environmental effect only accounts for some of the variation in birdsongs. That's probably true for our tongues too. "There are many reasons why some languages have more vowels or more consonants, and this is just one of them," Fitch says.

Other researchers say this is just the beginning of a line of research into how nature rules our speech. "This is the first of its kind, and there are several others coming now. It's becoming increasingly clear that the way we speak is shaped by external forces," says Sean Roberts, a researcher at the Max Planck Institute for Psycholinguistics in the Netherlands who was not involved in the study.

In his own work, Roberts found that arid, desertlike places are less likely to have tonal languages like Mandarin or Vietnamese. And he once analyzed a decades' worth of Larry King transcripts. "I carried the proportion of consonants to vowels that he was using and matched that to the actual humidity on the day he recorded those things," Roberts says. The longtime TV pundit used a few more consonants on dry days.

And the language you're reading now evolved in a cold, gloomy climate prone to light mist and drizzle. Fitch says: "English is quite a consonant-heavy language, and of course it didn't develop in a rain forest."

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Weight-Loss App Doesn't Help Young Adults Shed Pounds

NPR Health Blog - Fri, 11/06/2015 - 11:10am

If I log that milkshake do the calories still count?


Young American adults own smartphones at a higher rate than any other age group. Researchers from Duke University wanted to see if capitalizing on that smartphone usage with a low-cost weight-loss app might help the 35 percent of young adults in the U.S. who are overweight or obese.

If you're rooting for smartphones to solve all our health problems, you're not going to like what the researchers found. The smartphone app didn't help young adults lose any more weight than if they hadn't been using the app at all.

The study, which was published Wednesday in the journal Obesity, looked at 365 young adults ages 18 to 35. A third of the participants used an Android app specifically created for the study, which not only tracked their calories, weight and exercise but also offered interactive features like goal setting, games and social support.

Another third of the participants received six weekly personal coaching sessions, followed by monthly phone follow-ups. Plus, this personal coaching group was also encouraged to track their weight, calories and exercise via smartphone. The last third of the participants was put into a control group and given three handouts on healthy eating and exercise – nothing else.

Researchers tracked the young adults' progress after six months, one year and two years. The personal coaching group had lost more weight than the other two groups at the six-month mark, but that lead vanished at the one- and two-year follow-up. As for the group using the smartphone app, their average weight loss was never more than the other two groups.

Lead author Laura Svetkey says that she and her colleagues were both surprised and disappointed at the results. "Given the seeming power of cell phone apps and frankly the popularity of these health and fitness apps in the commercial world, we thought this might be a really good strategy to provide effective intervention very broadly and potentially at low cost," says Svetkey, a professor of medicine at Duke University School of Medicine.

But Svetkey says it's difficult to get the same level of intensity in an app that you might get through personal coaching. Plus, she says, people have the tendency to stop using weight-loss apps after a while. "We know that in general, the more engaged people are in intervention, the more they're going to succeed from it," Svetkey says. "And so perhaps we need to rethink how to make a weight-loss intervention on your cell phone more engaging."

There are good reasons to help young adults control their weight. Weight gain during the young adult years is associated with a variety of health issues later in life, including metabolic syndrome and cardiovascular disease, Svetkey says.

It's not clear if these results would apply to apps that are commercially available. Svetkey says she is only familiar with one clinical study that looked at a popular commercial weight-loss app, and it was also found to be ineffective at promoting weight loss. Yet, she says, that's not to say these apps won't work for certain people in certain circumstances.

We contacted Weight Watchers, which uses a combination of apps and coaching in a group setting, and MyFitnessPal, a very popular food and exercise tracking app, for comment but didn't receive a response.

These study results aren't reason to give up hope about the potential for weight-loss apps, Svetkey adds, but instead are reason to intensify research efforts. More work is needed to understand how to harness the technology and leverage its strengths in a way that will lead people to change their eating and exercise behaviors, she says.

Since I'm a young American adult who uses a popular weight-loss app on my iPhone, I wondered if there was any real harm in using one of these apps, even if they aren't proven effective in research studies. I asked Svetkey for her thoughts.

"We have a very serious epidemic," she told me, "and if we're spinning our wheels on things that don't work then that's energy not being put towards finding and disseminating things that do work."

Copyright 2015 Kaiser Health News. To see more, visit
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Should Human Stem Cells Be Used To Make Partly Human Chimeras?

NPR Health Blog - Fri, 11/06/2015 - 3:39am
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Human stem cells, in this case made from adult skin cells, can give rise to any sort of human cell. Some scientists would like to insert such cells into nonhuman, animal embryos, in hopes of one day growing human organs for transplantation.

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An intense debate has flared over whether the federal government should fund research that creates partly human creatures using human stem cells.

The National Institutes of Health declared a moratorium in late September on funding this kind of research. NIH officials said they needed to assess the science and to evaluate the ethical and moral questions it raises. As part of that assessment, the NIH is holding a daylong workshop Friday.

Meanwhile, some prominent scientists worry that the NIH moratorium is hindering a highly promising field of research at a crucial moment. Such concerns prompted several researchers this week, writing in the journal Science, to call on the NIH to lift the moratorium.

"The shadow of negativity cast around this research is going to have a major negative impact on any progress going forward," says Sean Wu, a cardiologist and assistant professor of medicine at Stanford University, who helped write the article.

The moratorium was prompted by an increasing number of requests to fund these experiments, says Carrie Wolinetz, the NIH's associate director for science policy. In the experiments, scientists propose to insert human stem cells into very early embryos from other animals, creating dual-species chimeras.

"The science is knocking at our door," Wolinetz told Shots in advance of the workshop. She says NIH wants to "make sure that we are fully prepared from a policy and guidance point of view" before making decisions about such grants.

Scientists have been creating partly human chimeras for years. Researchers use rats with human tumors to study cancer, for example, and mice with human immune systems to do AIDS research.

What's new is putting human stem cells into the embryos of other animals, very early in embryonic development.

"The special issue here with stem cells is that those types of human cells are so powerful and so elastic that there's great worry about the degree to which the animals could become humanized," says Insoo Hyun, a bioethicist at Case Western Reserve University.

The goal of the research is to create chimeras that lead to new treatments for human diseases. For example, the technique might enable scientists to create better animal models for studying diseases in the laboratory.

Researchers also hope to grow human organs in animals that would be closely matched to patients needing transplants.

"This could have a big impact in the way medicine is practiced," says Juan Carlos Izpisua Belmonte, a professor of gene expression at the Salk Institute for Biological Studies.

"We don't have enough organs for transplantation," Belmonte says. "Every 30 seconds of every day that passes, there is a person that dies that could be cured by using tissues or organs for transplantation."

He tells Shots he thought he was on the verge of getting an NIH grant to pursue this research before the moratorium was imposed.

The prospect of inserting human cells into early animal embryos raises a variety of concerns.

Françoise Baylis, a bioethicist at Dalhousie University in Nova Scotia, Canada, says the engineering of creatures that are partly human and partly nonhuman animal is objectionable because the existence of such beings "would introduce inexorable moral confusion in our existing relationships with nonhuman animals, and in our future relationships with part-human hybrids and chimeras."

Another concern is that the human cells could end up in the brains of the animals. That raises the prospect that "this will somehow give the animal a human consciousness, human mental capabilities," says Hank Greely, a bioethicist at Stanford University.

In addition, some scientists and bioethicists fear the stem cells could create human eggs and sperm in the animals.

"If you had a male mouse that had human sperm in it, that's going to be a concern to some people, especially if it's anywhere near a female mouse that has human eggs in it," Greely says. "To say the least, it's disconcerting to think about two mice making a human embryo."

Still, Greely, Hyun and the scientists conducting the research all agree that the most alarming concerns are highly unlikely. And, they say, safeguards could be put in place to allow the research to go forward.

For example, scientists could engineer the cells so that they were unable to form human brain cells, sperm or eggs. The animals could also be isolated or sterilized to prevent them from breeding.

"There are certainly very effective strategies that would alleviate the concerns," Wu says.

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Authors Retract Study That Says Sadness Affects Color Perception

NPR Health Blog - Thu, 11/05/2015 - 3:50pm

You'd be looking blue, too, if you realized you'd made big errors in your research.

Christopher Thorstenson/Open Science Framework

In September, we reported on a charming little study that found people who feel blue after watching sad videos have a harder time perceiving colors on the blue-yellow axis.

Now the researchers may be feeling blue themselves. On Thursday they retracted their study, saying that errors in how they structured the experiment skewed the results.

Shortly after the study was published online, commenters started looking skeptically at the results. And because the researchers had posted their data online, those commenters were able to run the numbers themselves. They didn't like what they found.

As one blogger wrote:

"A major problem is that the authors are claiming that they've found an interaction between video condition and color axis, but they haven't actually tested this interaction, they've just done a pair of independent t-tests and found different results."

As the indefatigable crew at the Retraction Watch blog points out, it's not the first time scientists have messed this up.

"This exact experimental oversight occurs all too often, according to a 2011 paper in Nature Neuroscience, which found that the same number of papers performed the procedure incorrectly as did it correctly."

And there were other problems, too, such as not testing participants' color perception before the study. Arguably this is the sort of thing that should have been caught by the authors' advisers and by the journal reviewers. But there's a lot of iffy science published in peer-reviewed journals that never gets retracted.

The editor of Psychological Science, the journal that published the study, gave the authors props for having owned up to their mistakes and retracting the work swiftly:

"Although I believe it is already clear, I would like to add an explicit statement that this retraction is entirely due to honest mistakes on the part of the authors."

The authors, Christopher Thorstenson, a graduate student in psychology at the University of Rochester, and colleagues Adam Pazda and Andrew Elliot, say that they plan to do the experiment over:

"We remain confident in the proposition that sadness impairs color perception, but would like to acquire clearer evidence before making this conclusion in a journal the caliber of Psychological Science."

Embarrassing as this must have been, in some ways this is a good news story for science. Independent scientists put a lot of time into uncovering the errors, and the authors and the journal fessed up and pledged to do better.

And no one's going to get the wrong medical treatment or die because of the errors. It just might make us a little more, well, blue.

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Stereotypes About Teens Can Undermine Parents' Confidence

NPR Health Blog - Thu, 11/05/2015 - 2:33pm

Parents, don't let your views of adolescence get you down.

Stereotypes about adolescents can make moms and dads feel less confident about their parenting skills right at a time kids need their parents to be present in their lives.

Raising teens is commonly perceived to be a total drag. Indeed, moms and dads of adolescents report feeling less capable than parents of younger children. And what parents think about adolescence can affect how competent they feel when dealing with their teens.

When moms and dads believe they can manage their children's issues and encourage positive behavior, they are more likely to parent effectively. That, in turn, makes it less likely their adolescents will act out, according to developmental psychologists Terese Glatz of Örebro University in Sweden and Christy Buchanan of Wake Forest University.

But parents feel especially stressed during adolescence, explains Glatz, as they expect those years to be difficult. This reputation is not entirely fair: On average, difficult behaviors and negative emotions increase during adolescence, yet overall the levels remain low, says Buchanan. "Adolescents are a group for whom negative stereotypes are still tolerated," she adds.

To discover what undermines parents' confidence, Glatz and Buchanan queried a diverse group of nearly 400 American parents three times over three years, beginning when their children were in sixth or seventh grade. This mix of moms and dads answered questions about how they viewed their own parenting skills; how competent they felt dealing with discipline and other tasks; and whether they believed they could influence their children's behavior.

The group also described their children's stage of puberty, their expectations for adolescence, their kids' current behavior and their views on how well they communicated with their kids.

Overall, parents' feelings of competence and their belief in their influence declined from the early- to middle-adolescent years, Glatz and Buchanan reported in the October Developmental Psychology. They found that parents whose children were less physically mature — and likely witnessed changes related to puberty during the study — experienced a larger decline in confidence than did parents whose children were more physically mature.

Moms and dads also felt less effective if they found it difficult to talk to their adolescents. And the stereotype of teens as risk-takers had an impact: Parents who expected their adolescents to engage in risky behavior were less comfortable handling discipline and conflicts. "These expectations matter above and beyond the child's actual behavior," says Buchanan.

Adolescents need their parents to be engaged in their lives and to give them opportunities to assert their independence, the researchers explain. It is not a time to pull back over anxiety or misconceptions.

"If we can change society's ideas of adolescence as a period of storm and stress," notes Glatz, it may be possible to help parents stay involved. "We have to be realistic, but not overly negative," adds Buchanan. "There is a lot of good that happens in adolescence."

Aimee Cunningham is a freelance science journalist based in the Washington, D.C., area.

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Powerful 'Gene Drive' Can Quickly Change An Entire Species

NPR Health Blog - Thu, 11/05/2015 - 5:06am
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Biologist Ethan Bier runs a laboratory at the University of California, San Diego where fruit flies are used to help unravel the processes that lead to some human diseases. One day recently, a graduate student in the lab called him over to take a look at the results of the latest experiment.

Bier was stunned by what he saw. "It was one of the most astounding days in my personal scientific career," Bier says. "When he first showed me, I could not believe it."

His student, Valentino Gantz, had found a way to get brown fruit flies to produce blond-looking offspring most of the time.

"When the next generation came out and almost all the kids were blond," Bier says, everyone in the lab was "jumping up and down."

Turning fruit flies from brown to yellow might not sound like a major achievement. But it was. It showed that scientists had a very fast and easy way to permanently change an entire species.

"I believe it's going to transform the world of genetics," Bier says, "because it's going to allow researchers to bypass the rules of genetics in many different spheres of activity."

Scientists have known for years how to genetically engineer many living things. Sometimes, the genetic changes are passed down to offspring.

What Gantz demonstrated was a new technique that could make that happen almost every time. Scientists call it a "gene drive."

The drive is a sequence of DNA that can cause a mutation to be inherited by the offspring of an organism with nearly 100 percent efficiency, regardless of whether it's beneficial for that organism's survival.

By combining it with new genetic editing techniques, scientists are able to drive changes they make quickly through an entire species.

"The gene drive immediately makes the organisms that carry it have the characteristic, and then secondly it causes them to have all their children have the same characteristic," Bier says.

The advance is raising excitement about possible real-world uses, such as fighting diseases like malaria by changing mosquitoes that spread malaria so that they can no longer carry the parasite. The technology might also help with other insect-borne diseases such as West Nile, dengue fever and Lyme disease.

But the approach is also raising serious concerns.

The major issue is uncertainty about what would happen if scientists start to release these genetically engineered creatures from their labs.

"There are inherent problems with gene drives," says Brendan Parent, a bioethicist at New York University. "We don't know what other impacts we're having."

The engineered organisms could upset the delicate balance of an ecosystem, inadvertently destroying other species, causing new diseases to emerge or prompting existing illnesses to spread to new places, Parent says.

"We don't know whether the elimination of malaria specifically won't somehow have genetic effects that cause a super-virulent pathogen to be released or to bring in much greater catastrophic consequences," Parent says.

Some worry that the technology could end up in the hands of terrorists.

"If any group or country wanted to develop germ warfare agents, they could use techniques like this," says Stuart Newman, a cell biologist at the New York Medical College. "It would be quite straightforward to make new pathogens this way."

Scientists have known about gene drives for many years. But they never had a good way to use them.

"All of this changed two years ago when several groups, including one that I worked with, developed CRISPR," says Kevin Esvelt, an evolutionary engineer who works on gene drives at Harvard.

The technique called CRISPR/Cas9 makes it much easier to edit DNA.

Scientists were able to combine precise CRISPR edits with a gene drive to make the changes stick.

Esvelt and other scientists working with gene drives dismiss concerns that the technology might be used by terrorists. They argue that terrorists have much easier ways to attack. But they acknowledge that the technology is so potent that scientists have to proceed very carefully.

"There are profound ethical issues here," Esvelt says. "That's why we need to handle this differently from the way that we traditionally handle scientific advances," he says.

Esvelt, Bier and other scientists working with gene drives say they are taking extra precautions to make sure none of their engineered insects or microbes escape by accident. They are also working on ways to program any living things changed this way with molecular switches they could turn off if something bad does happen.

"What that means is if someone makes a mistake, then we can undo that change," Esvelt says.

They argue that the potential benefits from gene drives are so great that it's important to find safe ways to use the technique.

Besides fighting human diseases, scientists also are exploring the use of gene drives to stop bugs from eating crops, which could enable farmers to use less pesticide. Bacteria that are genetically engineered this way could be used for many things, including cleaning up oil spills.

"It is potentially a way for us to interact with nature in a whole new way — using biology rather than bulldozers and toxic pesticides," Esvelt says.

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Slow Going For Small Businesses And Health Exchanges

NPR Health Blog - Thu, 11/05/2015 - 5:03am

Kentucky has run one of the most successful Obamacare individual health insurance exchanges, attracting enough people into private health plans and Medicaid to cut the state's uninsured rate by half in two years.

But Kentucky's online health insurance marketplace for small employers also created by the Affordable Care Act has mostly been a dud. Just 92 employers have signed up, and a total of 901 people, both workers and their dependents, have received coverage through the specialized exchange.

Kentucky isn't the only state with paltry enrollment in the online marketplaces known as the Small Business Health Options Program, or SHOP, that generally started in 2014.

Sixteen states plus the District of Columbia run their own marketplaces for small-business health insurance plans. As of October, several state-run SHOP exchanges in addition to Kentucky had sold coverage to fewer than 200 employers including Idaho, Maryland, Minnesota and Washington.

New York and California have the highest enrollments, and together those two states account for about 6,500 employers and almost 50,000 people.

Sign-ups in the state-run exchanges parallel the low totals achieved by the federally run SHOP exchange that operates in 34 other states. Altogether, about 11,000 employers and 85,000 people signed up for coverage there, according to the latest federal data released in May. That's less than 1 percent of the U.S. small-group-insurance market, which in 2013 had about 16.7 million people enrolled in health plans, according to Mark Farrah Associates, a market data firm.

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The weak performance stems partly from small businesses' still having decent alternatives outside of SHOP — at least until 2017. That's when employers will have to begin buying plans that fully meet Obamacare's requirement to provide essential health benefits. The grace period small employers are in now gives them access to less expensive policies that make SHOP plans less appealing.

Other factors also have played a role in SHOP's low sign-ups, including software problems in some state programs and a yearlong delay that kept the federal SHOP exchange from being fully operational until 2014.

Employers with fewer than 50 full-time workers are eligible to buy coverage on SHOP. The federal government even offers businesses an incentive — a tax credit worth up to half an employer's share of its workers' premiums. But there are some conditions. Among them: The firm must employ fewer than 25 workers and the average annual salary can't exceed $50,000. The credit is hardly used in high-cost areas of the country where pay is higher.

The longest-running small-business exchange in the country is in Utah, which started one in 2010 using state funds. It has attracted 698 employers and a total of 14,332 people.

Other states are moving to change their programs.

Hawaii, citing fewer than 250 employers enrolled and only 1 in 5 insurers selling plans, has asked the Obama administration for permission to drop its SHOP exchange for 2017.

Elsewhere, Arkansas this month launched its own SHOP exchange, but with only one insurance carrier — Blue Cross and Blue Shield of Arkansas, which was required to participate. Cheryl Gardner, executive director of the exchange, said she expects few employers to enroll initially and will consider it successful if the technology works.

With the federal government running the state's SHOP exchange in the first year, fewer than 200 people enrolled. The Arkansas exchange has spent about $4 million to get up and running.

The Kentucky SHOP exchange, which used millions of dollars in federal grants to get set up, costs about $125,000 to run each year.

Carrie Banahan, executive director of Kynect, the state exchange for individual and small-group policies, said she's not surprised small employers haven't rushed to SHOP.

"When we first launched it was very onerous and burdensome and clunky to enroll, and employer groups and agents took the position, 'We are not going to use SHOP,' " she said. The exchange has worked to fix technological challenges, but Banahan said the biggest obstacle now is that employers still can save money by staying with their existing policies sold outside the exchange. Those plans don't have to meet all the new Obamacare rules so they tend to have lower premiums, but they will have to comply starting in 2017.

"We will increase enrollment this year, but we won't see big change until 2017," Banahan said.

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California Law Adds New Twist To Abortion, Religious Freedom Debate

NPR Health Blog - Wed, 11/04/2015 - 7:11pm
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Roughly 800 women a year seek a free pregnancy test, counseling and other services at this center in El Cajon, Calif. The clinic encourages its clients to not get abortions, but a new law requires it to also prominently post information about where to find abortion services.

Becky Sullivan/NPR

The latest front in the debate over religious freedom is all about an 8 1/2-by-11-inch piece of paper.

This particular piece of paper is a notice — one the state of California will soon require to be posted in places known as crisis pregnancy centers. These resource centers, often linked to religious organizations, provide low-cost or free services to pregnant women, while encouraging these women to not have abortions.

The new notice is mandated by the Reproductive FACT Act, and would make it clear that abortion is legally available in California.

But several pregnancy centers are suing the state, asking for the law to be struck down.

It's like telling the Alcoholics Anonymous group that they have to have a large sign saying where people can get alcohol and booze for free.

One of the clinics engaged in the lawsuit is the East County Pregnancy Care Clinic in El Cajon, Calif., just outside San Diego. The center describes itself as "a religious, nonprofit, pro-life, free medical clinic licensed by the State of California." It sits on the corner of a busy intersection, surrounded by strip malls.

A big sign out front says "free pregnancy tests." That's one way they get women in the door, according to executive director Josh McClure.

McClure is not a physician, though the clinic does have medical advisers who are doctors, he says. When we recently visited, he didn't permit NPR to talk to clinic staff, who are all either registered nurses or volunteers. But he did offer to show us around and walk us through the process of what happens to clients who come to the clinic thinking they may be pregnant.

Most of these women make appointments, he says, but the clinic also receives one or two walk-ins a day. The staff see about 800 women a year, and that number is on the rise.

First, clients fill out paperwork in the lobby, he explains, then are assigned to a volunteer he describes as an "advocate."

These volunteer advocates, who are not medical professionals, take the client into a small room called the library. There the volunteer leads the client through a conversation about her situation.

McClure says his volunteer will ask the client a series of questions to get at these issues: "Why do they think they're pregnant? [Are] they living with somebody? Is it a husband, boyfriend? What are the circumstances going on in their life? And if the pregnancy does happen to be positive, what are they thinking about right then?"

The library has two shelves with books like What to Expect When You're Expecting; anatomy models that show the size of the fetus at four weeks of gestation, eight weeks and so on; and VHS tapes about abortion and abortion providers. McClure says the tapes are from the 1970s and are hardly ever used.

After a client speaks with the advocate and reviews the pamphlets, she is taken to an exam room to take a pregnancy test.

The exam room looks like any medical examining room, with clean linoleum floors, health pamphlets, and a box of rubber gloves on the counter. In the center of the room is an exam table with a sheet of white tissue paper laid out over it.

Women can get a free pregnancy test and a free ultrasound at the clinic, as well as counseling regarding three options — parenting, adoption and abortion. The clinic will not refer clients for abortions.

Becky Sullivan/NPR

That's where a registered nurse would hand the patient a specimen cup to get a urine sample and do a pregnancy test, McClure says. It's the same test you might buy at a drug store, he says, but here it's free, funded by donations. The R.N. signs off on the results.

If the pregnancy test is positive, the nurse tells the client there are three options: parenting, adoption or abortion.

"We're going to talk about the benefits, responsibilities and side effects of all three," McClure says. "We would say, if it's an unplanned pregnancy, there really aren't any good solutions. They're all hard."

In the discussion of parenting, the nurse talks about the responsibility of an 18-year commitment to another human life, and the resources in the client's life that may be helpful. The nurse asks whether a boyfriend or husband would be involved.

In discussing adoption, the clinic goes over several different options: familial adoption to a family member, local or national adoptions, and open or closed adoption. McClure says the clinic works with several different adoption agencies and will refer clients to the one that best suits her preferences.

"We do let them know, that if there's drug abuse, the reality is if you're not going to straighten your life out by the time the baby is here, that [Child Protective Services] would be coming to take that child," he says.

When it comes to abortion, the nurses do not tell clients where they can get an abortion or refer them to abortion providers, McClure tells us. But they will talk about the clinic's view of the risks of an abortion and the cost.

"Generally," McClure says, "the further along you go, the more expensive and more invasive and more risks there are. Risk of sterility is one. Perforated uterus is another. And then, of course, emotional side effects as well. All the information we're giving about the side effects is backed by research and referenced."

McClure didn't mention during our tour that at least some claims in that pamphlet used to train the clinic's nurses and volunteers are disputed by leading research organizations. For example, the suggestion that there might be a link between abortion and an increased risk of breast cancer has been studied and dismissed by the National Cancer Institute and other medical groups.

The clinic's pamphlet also states that abortion "significantly increases the risk" for conditions such as "clinical depression and anxiety" and "suicidal thoughts and behavior." But an American Psychological Association task force on mental health and abortion had a different take in its recent review, recognizing that "abortion encompasses a diversity of experiences."

According to the APA's task force report in 2008, "the best scientific evidence published indicates that, among adult women who have an unplanned pregnancy, the relative risk of mental health problems is no greater if they have a single, elective first-trimester abortion than if they deliver that pregnancy. The evidence regarding the relative mental health risks associated with multiple abortions is more equivocal."

Once a pregnant woman at McClure's clinic has been briefed by the staff on how their organization views the risks of abortion, she is brought to a room where she can get an ultrasound scan, free of cost.

There, McClure tells us, the ultrasound image is enlarged and projected onto a big flat-screen TV. Women often decide against abortion, he says, after they see the ultrasound.

"When you have an image on a screen, all the cloudiness of what we're talking about kind of goes away," McClure says. "They're able to see for themselves: OK, arms, legs, eyes, head. Bingo — that's a baby."

In its "care closet," the East County Pregnancy Care Clinic keeps donations of diapers, baby clothes, wipes, maternity clothes and other items to help clients who can't afford such supplies on their own.

Becky Sullivan/NPR

The last stop is a closet full of diapers, wipes, baby clothes, blankets and maternity clothes — all available for free to clients who have trouble affording those things.

That's the end of the tour.

None of these things — no step in that process — would have to change under the Reproductive FACT Act.

Instead, the law requires centers like the East County Pregnancy Care Clinic to post a sign in the lobby that says, in 22-point type:

California has public programs that provide immediate free or low-cost access to comprehensive family planning services (including all FDA-approved methods of contraception), prenatal care, and abortion for eligible women. To determine whether you qualify, contact the county social services office at [insert the telephone number].

If the center is not a licensed medical clinic, the sign would state:

This facility is not licensed as a medical facility by the State of California and has no licensed medical provider who provides or directly supervises the provision of services.

McClure says a sign in the lobby is not how or when he wants his clients at the clinic to hear about abortion. It goes against everything his center stands for, he tells NPR.

One of the people responsible for the law requiring this new sign is Autumn Burke, who represents Inglewood in the California Assembly.

Burke tells NPR that her interest in the issue started the day she went to get her phone fixed at a shop near a clinic that performs abortions. Protesters outside the clinic gave her pamphlets, she says, making claims that she knew weren't true.

"It [said] that abortion causes breast cancer," Burke recalls, "that if you are on birth control boys will not like you, or they will take advantage of you."

A few days later, one of Burke's colleagues in the California Assembly asked her to co-sponsor the Reproductive FACT Act.

"And I thought, you know what? This is timely — making sure women have the correct information," Burke says.

A number of health and medical groups, including the regional district of the American Congress of Obstetricians and Gynecologists, the California Nurses Association and the Primary Care Association also supported the legislation.

Burke acknowledges that some crisis pregnancy centers do give good help to women who want to have babies. But she says that others give false information to women, or pose as clinics even though they don't have a medical license.

Burke says the law is for those bad actors, and that putting up this sign in these centers wouldn't be much different from a notice from the health department or the building inspector.

"It's like a 'Wash Your Hands' sign on the wall," says Burke.

Brad Dacus of the Pacific Justice Institute, one of the groups suing the state of California over the new law, could not disagree more.

"It's like telling the Alcoholics Anonymous group that they have to have a large sign saying where people can get alcohol and booze for free," Dacus says. "It's like telling a Jewish synagogue that they can have their service, and do their thing, but they have to have a large sign where people can go to pray to receive Jesus."

Dacus' organization has filed a challenge to the law in federal court.

Some U.S. cities, including Austin, Texas, Baltimore and San Francisco, have passed similar legislation and have faced similar legal challenges — with mixed results.

The state of California so far is the largest jurisdiction in the country to pass a law requiring these centers to inform women about the availability of abortion services. If the law holds up, it could make way for measures like it in other cities and states.

Brad Dacus says that if the case has to go all the way to the Supreme Court to stop the law, so be it. To him, the legal battle is all about upholding the right to religious freedom.

"If people are not allowed to carry out their faith, and act and actually exercise their faith — not just have their private beliefs, but actually exercise their faith — then we really don't have religious freedom," Dacus says.

The lawsuits against the Reproductive FACT Act are now making their way through the courts.

Kristin Ford, representing the office of California Attorney General Kamala Harris, says, "We will vigorously defend the state law in court."

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